CERTIFICATE OF ACCLIMATION

Name:
Address:
City:
State:
Phone:
Phone: (2)

DATE:_______________

Shipper/Owner
___________________________________
___________________________________
___________________________________
___________________________________
_______________
Zip: ____________
___________________________________
___________________________________

Name:
Address:
City:
State:
Phone:
Phone: (2)

Consignee/Owner
__________________________________
__________________________________
__________________________________
__________________________________
_______________
Zip: ___________
__________________________________
__________________________________

Animal Data
Number of pets in this shipment belonging to this family ________
Animal #1
Species ________ Name _______________ Breed _______________ Color ________________
Age _________ Wt ___________ Sex ______________ Current License# __________________
Animal #2
Species ________ Name _______________ Breed _______________ Color ________________
Age _________ Wt ___________ Sex ______________ Current License# __________________
Animal #3
Species ________ Name _______________ Breed _______________ Color ________________
Age _________ Wt ___________ Sex ______________ Current License# __________________
Animal #4
Species ________ Name _______________ Breed _______________ Color ________________
Age _________ Wt ___________ Sex ______________ Current License# __________________
Statement:
This is to certify that the animal(s) described in this shipment appear(s) healthy for transport, but need(s)
to be maintained at a temperature within the animal(s) thermoneutral zone. The above described animal(s)
is/are cleared for travel at temperatures ranging from _____F/C to _____F/C.
U.S.D.A. Accredited Veterinarian ____________________________________ __________________
Signature
Date signed
_______________________________________________________
Accreditation Number / State
Owners/Agents Signature

___________________________________ ___________________
Date signed